Comparison of a New Self-Gripping Mesh with Other Fixation Methods for Laparoscopic Hernia Repair in a Rat Model

Hollinsky, Christian; Kolbe, Thomas; Walter, Ingrid; Joachim, Anja; Sandberg, Simone; Koch, Thomas; Rülicke, Thomas

doi:10.1016/j.jamcollsurg.2009.01.046

« Previous Next »Journal of the American College of Surgeons
Volume 208, Issue 6 , Pages 1107-1114, June 2009

Comparison of a New Self-Gripping Mesh with Other Fixation Methods for Laparoscopic Hernia Repair in a Rat Model

Christian Hollinsky, MD
- Department of Surgery, Kaiserin Elisabeth Hospital, Vienna, Austria
- Correspondence address: Christian Hollinsky, MD, Department of Surgery, Kaiserin Elisabeth Hospital, Huglgasse 1-3, Vienna 1150, Austria
Thomas Kolbe, PhD
- University of Veterinary Medicine, Institute of Laboratory Animal Science and Biomodels, Vienna, Austria
Ingrid Walter, PhD
- University of Veterinary Medicine, Institute of Histology and VetBioBank, Vetomics Core Facility for Research, Vienna, Austria
Anja Joachim, DVM
- Department of Pathobiology, University of Veterinary Medicine, Institute of Parasitology and Zoology, Vienna, Austria
Simone Sandberg, MD
- Department of Surgery, Kaiserin Elisabeth Hospital, Vienna, Austria
Thomas Koch, PhD
- Vienna University of Technology, Institute of Materials Science and Technology, Vienna, Austria
Thomas Rülicke, PhD
- University of Veterinary Medicine, Institute of Laboratory Animal Science and Biomodels, Vienna, Austria

Received 25 October 2008; received in revised form 22 December 2008; accepted 21 January 2009. published online 17 April 2009.

Background

Microhooks are small structures on the surface of the Progrip (PG; Sofradim Corp) mesh to ensure its anchorage in tissue. Additional fixation is not required. The aim of this animal study was to compare the strength of incorporation, foreign body reaction, and changes in material after implantation of this novel mesh with the current fixation alternatives, namely the hernia stapler (HS) and fibrin glue (FG).

Study Design

Forty Sprague-Dawley rats were used in this two-phase, prospective randomized study. Polypropylene meshes (Parietene light; Sofradim Corp) were positioned bilaterally on the abdominal muscle. The randomized mesh fixation groups were named HS, FG, PG, and UM (unfixed mesh). Half of the rats in each group were sacrificed and analyzed 5 days after implantation, and the second half were sacrificed and analyzed after 2 months. Measured parameters were strength of incorporation, foreign-body reaction to, and potential degradation of, mesh and fixation systems.

Results

After 5 days, strength of incorporation was substantially higher for PG (3.2 N/cm²) and HS (2.7 N/cm²) compared with FG (0.9 N/cm²) or UM (1.5 N/cm²). After 2 months, PG had a much greater strength of incorporation (14.8 N/cm²) compared with all other groups (HS 11.7 N/cm²; FG 11.4 N/cm²; UM 8.7 N/cm²). Inflammatory reactions were considerably more severe after 5 days than after 2 months. No significant differences in foreign-body reactions were found between groups. At neither time point were signs of degradation detected by scanning electron microscopy.

Conclusions

PG demonstrated a substantially stronger strength of incorporation in muscle tissue compared with other fixation systems and is an economic alternative to HS or FG. Laparoscopic mesh placement of PG requires some practice because of the microhooks. Clinical studies will have to be performed before the value of this mesh can be established for laparoscopic application.

Abbreviations and Acronyms: FG, fibrin glue, HS, hernia stapler, PG, Progrip, TAPP, transabdominal preperitoneal, UM, unfixed mesh